1114570009 NPI number — CHRISTINA MARIE SWEATT FNP-C

Table of content: CHRISTINA MARIE SWEATT FNP-C (NPI 1114570009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114570009 NPI number — CHRISTINA MARIE SWEATT FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWEATT
Provider First Name:
CHRISTINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114570009
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
291 CARTER DR STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19709-5845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-365-2202
Provider Business Mailing Address Fax Number:
844-558-1878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 SILVERSIDE RD STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19809-1768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-365-2202
Provider Business Practice Location Address Fax Number:
844-558-1878
Provider Enumeration Date:
07/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  LG-0001287 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: LG-0001287 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 250549890 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250696934 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250719473 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250719474 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250697026 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250721016 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com